|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
7982915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,679.15 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.00
|
| Rate for Payer: Aetna of IA Medicare |
$638.40
|
| Rate for Payer: Amerigroup Medicaid |
$646.02
|
| Rate for Payer: Amerigroup Medicare |
$509.04
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$504.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$639.74
|
| Rate for Payer: Medical Associates Commercial |
$840.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$504.00
|
| Rate for Payer: Midlands Choice Commercial |
$784.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$649.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$579.60
|
| Rate for Payer: United Healthcare Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$660.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,524.35
|
| Rate for Payer: Wellmark IA PPO |
$1,679.15
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
4866844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Aetna of IA Medicare |
$376.20
|
| Rate for Payer: Amerigroup Medicaid |
$380.69
|
| Rate for Payer: Amerigroup Medicare |
$299.97
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$297.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$376.99
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$382.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$341.55
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$389.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$336.78
|
| Rate for Payer: Wellmark IA PPO |
$370.98
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
7982761
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$89.63 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Amerigroup Medicaid |
$90.51
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.63
|
| Rate for Payer: Medical Associates Commercial |
$465.00
|
| Rate for Payer: Midlands Choice Commercial |
$434.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$465.00
|
| Rate for Payer: United Healthcare Commercial |
$281.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$358.30
|
| Rate for Payer: Wellmark IA PPO |
$421.50
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
4866844
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7982815
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.35 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Amerigroup Medicaid |
$52.86
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.35
|
| Rate for Payer: Medical Associates Commercial |
$83.25
|
| Rate for Payer: Midlands Choice Commercial |
$77.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$76.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$101.90
|
| Rate for Payer: Wellmark IA PPO |
$119.90
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
7982814
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Amerigroup Medicaid |
$68.07
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.41
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$123.30
|
| Rate for Payer: Wellmark IA PPO |
$145.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.90 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Aetna of IA Medicare |
$229.14
|
| Rate for Payer: Amerigroup Medicaid |
$231.87
|
| Rate for Payer: Amerigroup Medicare |
$182.71
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$180.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.62
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.90
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.04
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.18
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4864802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna of IA Commercial |
$361.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$361.80
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$301.50
|
| Rate for Payer: Medical Associates Commercial |
$301.50
|
| Rate for Payer: Midlands Choice Commercial |
$281.40
|
| Rate for Payer: United Healthcare Commercial |
$361.80
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
4864800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$338.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$338.40
|
| Rate for Payer: Aetna of IA Medicare |
$214.32
|
| Rate for Payer: Amerigroup Medicaid |
$216.88
|
| Rate for Payer: Amerigroup Medicare |
$170.89
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$214.77
|
| Rate for Payer: Medical Associates Commercial |
$282.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.20
|
| Rate for Payer: Midlands Choice Commercial |
$263.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$217.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$194.58
|
| Rate for Payer: United Healthcare Commercial |
$338.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$221.84
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
4864800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna of IA Commercial |
$338.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$338.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$282.00
|
| Rate for Payer: Medical Associates Commercial |
$282.00
|
| Rate for Payer: Midlands Choice Commercial |
$263.20
|
| Rate for Payer: United Healthcare Commercial |
$338.40
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
4864798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
4864798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$782.56 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$201.88
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.92
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$202.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.12
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$710.42
|
| Rate for Payer: Wellmark IA PPO |
$782.56
|
|
|
DRAIN LOWER LEG LESION
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
7982865
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$447.17 |
| Max. Negotiated Rate |
$1,320.75 |
| Rate for Payer: Amerigroup Medicaid |
$451.55
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.17
|
| Rate for Payer: Medical Associates Commercial |
$1,320.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,232.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$449.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,320.75
|
| Rate for Payer: United Healthcare Commercial |
$803.92
|
| Rate for Payer: Wellmark IA HMO WHPI |
$996.30
|
| Rate for Payer: Wellmark IA PPO |
$1,172.20
|
|
|
DRAIN LOWER LEG LESION
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
7982943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$930.60 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,178.76
|
| Rate for Payer: Amerigroup Medicaid |
$1,192.82
|
| Rate for Payer: Amerigroup Medicare |
$939.91
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$930.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,181.24
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$930.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,198.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,070.19
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,220.12
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
DRAIN LOWER LEG LESION
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
7982943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
|
|
DRAIN THIGH/KNEE LESION
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
4864791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,809.50 |
| Max. Negotiated Rate |
$2,326.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,326.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,326.50
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,938.75
|
| Rate for Payer: Medical Associates Commercial |
$1,938.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,809.50
|
| Rate for Payer: United Healthcare Commercial |
$2,326.50
|
|
|
DRAIN THIGH/KNEE LESION
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
4864791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,163.25 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$2,326.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,326.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,473.45
|
| Rate for Payer: Amerigroup Medicaid |
$1,491.03
|
| Rate for Payer: Amerigroup Medicare |
$1,174.88
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,068.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,938.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,163.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,476.55
|
| Rate for Payer: Medical Associates Commercial |
$1,938.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,163.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,809.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,498.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,337.74
|
| Rate for Payer: United Healthcare Commercial |
$2,326.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,525.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
DRAIN THIGH/KNEE LESION
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
7982796
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$510.51 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Amerigroup Medicaid |
$515.52
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.51
|
| Rate for Payer: Medical Associates Commercial |
$1,678.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,566.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$513.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,678.50
|
| Rate for Payer: United Healthcare Commercial |
$1,015.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,284.40
|
| Rate for Payer: Wellmark IA PPO |
$1,511.10
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
7982817
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$104.03 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Amerigroup Medicaid |
$105.05
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$104.03
|
| Rate for Payer: Medical Associates Commercial |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$342.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$366.75
|
| Rate for Payer: United Healthcare Commercial |
$231.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$288.10
|
| Rate for Payer: Wellmark IA PPO |
$338.90
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
4864785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna of IA Commercial |
$149.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$149.40
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$124.50
|
| Rate for Payer: Medical Associates Commercial |
$124.50
|
| Rate for Payer: Midlands Choice Commercial |
$116.20
|
| Rate for Payer: United Healthcare Commercial |
$149.40
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
4864785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$149.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$149.40
|
| Rate for Payer: Aetna of IA Medicare |
$94.62
|
| Rate for Payer: Amerigroup Medicaid |
$95.75
|
| Rate for Payer: Amerigroup Medicare |
$75.45
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$124.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.82
|
| Rate for Payer: Medical Associates Commercial |
$124.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.70
|
| Rate for Payer: Midlands Choice Commercial |
$116.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.90
|
| Rate for Payer: United Healthcare Commercial |
$149.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.94
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
7982818
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$185.20 |
| Rate for Payer: Amerigroup Medicaid |
$53.18
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.66
|
| Rate for Payer: Medical Associates Commercial |
$164.25
|
| Rate for Payer: Midlands Choice Commercial |
$153.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$164.25
|
| Rate for Payer: United Healthcare Commercial |
$123.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$157.40
|
| Rate for Payer: Wellmark IA PPO |
$185.20
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
4864784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$182.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$182.70
|
| Rate for Payer: Aetna of IA Medicare |
$115.71
|
| Rate for Payer: Amerigroup Medicaid |
$117.09
|
| Rate for Payer: Amerigroup Medicare |
$92.26
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$91.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.95
|
| Rate for Payer: Medical Associates Commercial |
$152.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.35
|
| Rate for Payer: Midlands Choice Commercial |
$142.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$117.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.05
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$119.77
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
4864784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna of IA Commercial |
$182.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$182.70
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$152.25
|
| Rate for Payer: Medical Associates Commercial |
$152.25
|
| Rate for Payer: Midlands Choice Commercial |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
|
|
DRILL BIT 4.2X180MM AO SMALL
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
8046331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Aetna of IA Commercial |
$192.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$192.60
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$160.50
|
| Rate for Payer: Medical Associates Commercial |
$160.50
|
| Rate for Payer: Midlands Choice Commercial |
$149.80
|
| Rate for Payer: United Healthcare Commercial |
$192.60
|
|
